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NPI Code Detail

MEDICARE: DR. ADETOLA GBENGA MOWO-WALE MBCHB

MEDICARE: DR. ADETOLA GBENGA MOWO-WALE MBCHB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1457242851
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADETOLA GBENGA MOWO-WALE MBCHB
Provider Business Mailing Address
First Line : 33026 AUDREYS WAY
Second Line :
City : WESTLAND
State : MI
Zip : 48185-8528
Country : US
Telephone Number : 734-431-2336
Fax Number :
Provider Business Practice Location Address
First Line : 3031 W GRAND BLVD STE 600
Second Line :
City : DETROIT
State : MI
Zip : 48202-3014
Country : US
Telephone Number : 734-431-2336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2025
Last Update Date : 05/25/2026

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